If you have a patient that you would like to refer for a binocular vision assessment, visual skills assessment, and/or a post-concussion vision assessment, please fill out the following referral form. Our office will contact the patient directly to book the appointment and we will send your office an email once the appointment is booked. After the appropriate assessments, you will receive a comprehensive report with all relevant findings and results.

For referring eye care professionals, any patients referred by you will be returned to you for any glasses or contact lens dispensing required prior to or during vision therapy or rehabilitation treatment programs. Patients will also be returned to your care once the treatment programs are completed.

Referral forms can be emailed to visiontherapy@toniceyecare.com or faxed to 1 (437) 700-5562. Please do not hesitate to contact us with any questions. Thank you for allowing us to participate in your patients’ care and we look forward to co-managing with you.

Click here to download the form as a PDF.

Vision Therapy Referral Form

VISION THERAPY & POST-CONCUSSION VISION REHABILITATION SERVICES
REFERRAL FORM

Vision Therapy Referral Form​

VISION THERAPY & POST-CONCUSSION VISION REHABILITATION SERVICES REFERRAL FORM

Vision Therapy Referral Form

VISION THERAPY & POST-CONCUSSION VISION REHABILITATION SERVICES
REFERRAL FORM